HEALTH HISTORY...
For your convenience we have made it possible for you to complete and submit your medical history online. To use the medical history form, you must have Acrobat Reader 5 or later on your computer. Click here to download the latest version of Adobe Reader.
CLICK HERE TO DOWNLOAD OUR HEALTH HISTORY FORM
GENERAL
INSTRUCTIONS
To enter text, tab to (or click in) the location you wish to
type in and begin typing. To check off yes/no choices on the form, click
in the boxed area and an "X" (or check mark) will appear.
To print a copy of this form to retain for your records, click on the
"Print Form" button towards the bottom of the second page.
To send the completed form to our office, click the "Submit Form"
button toward the bottom of the last page. Follow the pop-up instructions;
you will be asked to use an application-based email (such as Outlook),
or web-based email (such as Hotmail).
DO
NOT ATTEMPT TO SIGN THE HISTORY FORM - YOU WILL SIGN AND DATE THIS
SECTION OF THE FORM AT OUR OFFICE. |
If you experience
difficulty submitting this form, please follow these directions:
1.Print the form.
2.Complete with black pen and bring the form to our office at the time
of your appointment.
3.If you do not have a printer, you can fill out the form at our office
prior to your appointment. If this is the case, please arrive early to
allow for time for this
For your protection, this form is hosted on a secure server; only our
office staff can view the document, which is HIPAA compliant.
